The perceptions of key stakeholders of the roles of specialist and advanced nursing and midwifery practitioners

Digital Health for Equitable Rheumatic Care: Integrating Real-World Experiences to Guide Policy Pathways

Background/Objectives: Digital health technologies show promise in improving rheumatic disease management and reducing healthcare access disparities globally. This paper examines how electronic health records, telemedicine, apps, and wearable devices are used in rheumatic care across different economic settings. Methods: The study evaluates digital health technology implementation and outcomes in high-income versus low- and middle-income countries (LMICs). Results: Digital health technologies demonstrate improvements in disease monitoring, treatment adherence, and doctor-patient communication, though impact varies by region. Key barriers include poor infrastructure, limited tech literacy, and the digital divide, particularly affecting LMICs. The proposed evidence-based framework recommends strategic investments in digital infrastructure, healthcare system integration, and professional training to address these challenges. Conclusions: Implementation of digital health technologies, guided by targeted interventions and regional adaptations, can effectively reduce global disparities in rheumatic care. Success requires sustained commitment to addressing infrastructure and literacy barriers while ensuring equitable access across all economic settings.

Advanced nurse and midwife practitioners' experience of interprofessional collaboration when implementing evidence-based practice into routine care: An interpretative phenomenological analysis

AIM

To understand advanced nurse and midwife practitioners' experience of interprofessional collaboration in implementing evidence-based practice into routine care.

DESIGN

A qualitative interpretative phenomenological analysis.

METHODS

A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis.

RESULTS

Six superordinate themes emerged: Understanding of advanced practice; 'Treated as an equal and as a "nurse"'; Nursing management support; 'A voice to implement anything new'; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice.

CONCLUSION

There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care.

IMPACT AND IMPLICATIONS

The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients.

CONTRIBUTION TO THE WIDER GLOBAL CLINICAL COMMUNITY

As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice. Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care.

REPORTING METHOD

Consolidated criteria for reporting qualitative research (COREQ).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Cost-effectiveness of bringing a nurse into an Italian genetic day clinic: a before and after study

BACKGROUND

Only a few studies explore the role of nurses in genetic counselling and genetic health care, and none of them is related to orphan diseases. In addition, few studies address the issue of finding variables that might affect the economy of a service or perform a cost-effectiveness analysis of a having genetic nurse at a unit.

METHODS

A multidisciplinary panel of experts working in the hospital was set up to identify sensitive indicators and remove confounding variables. This panel evaluated efficiency and effectiveness indicators and drafted a questionnaire to estimate patient perception of the quality of the service. Data were captured from different sources, including the hospital patient database and a web-accessible platform for data collection. More than 600 clinical evaluations of 400 patients were considered, and economic parameters were studied by applying Porter's Time-Driven Activity-Based Costing methodology to evaluate costs and outcomes. Additionally, an anonymous, semi-structured, paper-and-pencil interview questionnaire was given to patients at their periodic follow-ups.

RESULTS

The results showed an increase in the quality of patient management, more accurate data capturing, and higher quality ambulatory care. In fact, approximately 70% of the respondents reported positive changes. In addition, a parallel economic analysis explored indicators influencing economic impact, and outcomes showed positive results with the quality of outcomes improving more compared to the increase in costs.

CONCLUSIONS

The variety of evaluated issues highlighted that having a nurse in a genetic service and at day clinic activities resulted in better access, better scheduling, more satisfaction, and proved to be a cost-effective solution for patients affected by rare diseases.

Dynamics and processes influencing role integration of advanced practice nurses and nurse navigators in oncology teams

PURPOSE

Exploring the persisting presence of underlying processes, dynamics, experienced barriers and facilitators of Advanced Practice Nurses (APN) in oncology and Oncology Nurse Navigators (ONN) during their role integration in an interprofessional team over a research period of seven years.

METHODS

A qualitative study based on the principles of Grounded Theory, in which individual semi-structured interviews and focus groups were conducted with 51 ONN and APN from 11 university and local hospitals in Belgium between 2011-2018. Data were analyzed to develop a framework that consists of different themes.

RESULTS

ONN and APN experienced a lonely journey during role integration. They were searching for partners, medical knowledge and acknowledgement from the interprofessional team. ONN and APN had a watchful attitude and tried to make themselves visible to ensure they were involved in the team and to preserve their role and responsibilities. An unclear role description to the interprofessional team, and a lack of coaching and guidance were influencing factors in the experience of ONN and APN.

CONCLUSION

ONN and APN in oncology feel difficulties to integrate their role in existing interprofessional teams. A lack of role clarity, the interprofessional team environment and a desire for coaching and guidance are influencing factors to implement APN roles. Coaching and mentorship of novice ONN/APN and their interprofessional team and healthcare managers are needed to address these issues. These findings could form the basis for a mentorship program for ONN/APN and their interprofessional team to enhance role integration.

Identifying Structure, Process and Outcome Factors of the Clinical Specialist Nurse: A Scoping Review Study

Background

In order to achieve the major goals of transformation in the health care system, organizing and developing the existing potential properly play a pivotal role. The objective is to conduct a scoping review to describe available extent of literatures about scattered structure, process, and outcome factors of the clinical specialist nurse and redesign those as three cohesive and interconnected factors.

Materials and Methods

A scoping review of studies was conducted from 1970 to June 20, 2020, focusing on the structure, process, and outcome factors of the clinical specialist nurse from six databases.

Results

Forty-six studies were carried out. Structure (individual characteristics, intra-organizational, and governance factors), process (professional interactions, and roles and duties of a specialist nurse), and outcome (patient and family, nurse, and organizational outcomes) factors were identified.

Conclusions

With the correct knowledge of the factors, it is possible to achieve the desired therapeutic, organizational, and professional results of nursing by providing the necessary fields in the structure, process, and outcomes. The identification of structures, processes, and outcomes that influence clinical nurse's role implementation may inform strategies used by providers and decision makers to optimize these roles across healthcare settings and guarantee the delivery of high-quality care.

Contextual factors of advanced practice nursing development: A network analysis

AIMS

This study aimed to delineate the relationships between actors and contextual factors associated with the development of the advanced practice role in Catalonia.

METHODS

A complementary data analysis was conducted based on the social network analysis (SNA) method. The primary study design was qualitative, descriptive and explanatory. Participants from diverse perspectives of practice, organization and external environment were engaged to participate in semi-structured focus groups. Data collection was conducted between March and May 2016 in Catalonia, Spain. Participants were asked to report on various dimensions of the role development context: understanding of the role, felt needs, perceived outcomes, barriers and facilitators.

RESULTS

Primary data analysis performed for 44 participants identified 71 related contextual factors associated with role development. Complementary network analysis revealed multiple relationships and agreements among participants and context-related themes. Professional roles and disciplines clustered around topics show consensus and the significance of topics.

CONCLUSION

Understanding the level of interactions and consensus among participants and contextual factors will ultimately allow better insight into how complex contexts influence the development of advanced practice nursing in healthcare organizations. Significant, consensual contextual factors should be used to influence further development and implementation of new roles that affect patient care and outcomes.

The Role of Regulator and NGOs in Developing Credit Community and Consumer Sovereignty in Malaysia

The purpose of regulating the Credit Community industry is to standardise moneylenders’ business compliance so that consumers may freely choose where to pursue their moneylending transactions. Media reported an increasing trend on breaching of consumers’ sovereignty by the moneylenders in Malaysia. Thus, the primary role of regulation effectiveness comes into the limelight. It raises the question of whether regulation enhancement supports or deter consumers’ sovereignty. The study was undertaken in Selangor and Kuala Lumpur, where most of the consumers’ issues were handled by non-governmental organisations (NGOs). The phenomenology approach was used to extract the three NGO leaders’ experiences and four regulator officers’ when dealing with the consumers and the licensed moneylenders’ issues. Data from semi-structured interviews and moneylending literature were uploaded into Nvivo 12 for thematic analysis. Findings revealed three themes: the non-governmental organisations’ role as the “watchdog”, the regulator’s educational role, and the regulator’s role in uplifting consumers’ sovereignty. The findings reveal a tendency for consumers with moneylending issues to seek NGOs, which affect the effort of seeking redress. The implication is for the regulator to take the lead in strengthening a three-way working relationship involving the moneylenders’ associations and the NGOs to resolve consumers sovereignty issues.

Role dimensions of practice nurses and interest in introducing advanced nurse practitioners in general practice in Ireland

Background

Internationally many countries have implemented strategies to enhance primary care, to strengthen their health systems to cope with an aging population, the rise of chronic conditions, and increased costs. Primary care has the potential to address these challenges, however, general practitioners are increasingly struggling to meet patient demand resulting from a growing and aging population. Expanding the role of general practice nurses to advanced nurse practitioner (ANP) level has worked internationally and could equally be a solution to the Irish context. However, their current role must first be established as well as their level of interest in becoming an ANP.

Aim

To explore the role of general practice nurses and their interest in becoming an ANP.

Design

A survey design.

Method

A purposeful sample of general practice nurses (n = 40) was undertaken between April and June 2019. Data were analyzed using the Statistical Package for Social Science (SPSS V 25.0; IBM).

Results

General practice nurses appear to have an agenda in relation to activities associated with wound care, immunizations, respiratory and cardiovascular issues. Just over half of the respondents were not interested in becoming an ANP. Their perceived challenges associated with the implementation of the role include a lack of support from general practitioners, a lack of resources, insurance issues, and a lack of understanding of the role. Challenges were associated with undertaking further training and their experience of having more work transferred to general practice without concomitant reallocation of resources.

Conclusion

General practice nurses have extensive clinical experience to deliver major improvements in primary care. Educational opportunities need to be provided for upskilling existing general practice nurses to advanced practice level. Greater understanding of the role and the potential contribution of the role in general practice is required among medical colleagues and the public.

Sustaining the quality of midwifery practice in Belgium: Challenges and opportunities for advanced midwife practitioners

BACKGROUND

Midwifery practice is essential in achieving high-quality maternal and newborn care in all settings and countries. However, midwifery practice has become more complex over the past decades. Considerable demands are being placed on midwives to meet increasing epidemiological, socio-economic, and technological challenges. These require a well-trained midwifery workforce ready to shape the care in the near and long-term future.

OBJECTIVE

To discuss advanced midwife practitioner role implementation in Belgium as a possible answer to healthcare-related challenges that impact midwifery practice. Furthermore, to stimulate a debate within the profession at all levels in Belgium and in countries considering advanced midwife practitioner roles.

METHOD

The framework by De Geest et al. (2008) served as a basis for discussing the drivers for advanced midwife practitioner role implementation: the legal, policy and economic context, workforce issues, education, practice patterns, and healthcare needs of the population.

FINDINGS

A legal basis for advanced midwife practitioner role implementation is lacking in Belgium. Remuneration opportunities for the non-clinical part of these roles (e.g. leadership and innovation activities) are missing. It might be challenging for healthcare organisations to support the implementation of such roles, as immediate revenues of non-clinical activities are absent. However, sufficient potential resources are available to fill in future advanced midwife practitioner positions. Additionally, advanced midwife practitioner specific master programmes are being planned in the near future.

CONCLUSIONS

Although several barriers for the implementation of advanced midwife practitioner roles were identified, a discussion should be held on the opportunities of implementing these roles to facilitate the development of new models of care that meet current and future challenges in midwifery practice and healthcare. After initial discussions amongst midwives in academic, managerial, and policy positions, stakeholders such as obstetricians, general practitioners, associations representing healthcare organisations, and policy makers should be involved as a next step.

Does improved postgraduate capacity shift the balance of power for nurse specialists in a low-income country: A mixed methods study

AIM

To explore nurse specialists' experiences of change and influence on practice two years after graduating with a postgraduate degree.

BACKGROUND

In the absence of further study opportunities for nurses in their own country, a master's degree was introduced to train the first group of nurse specialists in Mozambique.

DESIGN

Within a hybrid evaluation framework an exploratory, sequential mixed methods design was followed.

METHODS

Qualitative data from focus group interviews with nurse specialists (N = 12) led to five thematic data sets from which survey questions were formulated for the sequential quantitative component.

FINDINGS

"Change expectations", "Ambiguous practice environments", "Feeling powerless", "Having some influence" and "Workplace support" were emergent themes from interview data. Areas of positive change occurred in research (100%) and the use of evidence (88.9%) and involvement in decision-making (77.8%). For some change did not happen as anticipated-reasons included lack of nurse mentors to support new graduates (55.6%); lesser respect compared with doctors (44.4%) and poor understanding of the value of a master's degree (44.4%). Improvements in service quality and elevating the status of nursing were areas of greatest influence (77.8%).

CONCLUSION

Several enabling and limiting factors were identified in the experiences of change and influence on practice of newly qualified nurse specialists. Tacit change with respect to the value of the degree in improving the status of nursing seems not to have affected nurse specialists' own ability and power to influence practice. Improved postgraduate capacity on its own does not empower nurses in their role as specialists.

IMPACT

The findings point to a two-tiered strategy to be developed to dismantle barriers to the empowerment and advancement of nurse specialists. The identification of designated nurse mentors is essential to induct and sustain newly graduated nurse specialists. A clear research policy should be developed that supports the conduct of relevant research and the use of evidence in specialist practice.

Enablers and challenges to advanced nursing and midwifery practice roles

AIM

To describe the enablers and challenges to the development and implementation of advanced nursing and midwifery practice roles in Ireland.

BACKGROUND

Leadership strategies need to be put in place to enhance the development and implementation of advanced nursing and midwifery practice roles.

METHOD

A descriptive qualitative approach using semi-structured interviews with key stakeholders (n = 15) was undertaken with nurses and midwives working in specialist and advanced practice roles and participants from other areas such as legislative, regulatory, policy, pharmacy, medicine and education.

RESULTS

Participant's perspectives on the enablers and challenges to enacting specialist and advanced practice roles resulted in the generation of three themes: organisational factors; collegial, interprofessional and interpersonal support; and role clarity, economic and regulatory contexts.

CONCLUSION

Addressing organisational factors, encouraging collegial and interprofessional support and establishing role clarity contribute to the effective development and implementation of the role of advanced practitioners.

IMPLICATIONS FOR NURSING AND MIDWIFERY MANAGEMENT

Managers of nursing services need to provide leadership in developing strategies to enhance the enablers and overcome the challenges to advanced practice role development in their own organisation.

Intercountry master's degree in nursing: policy implications for the Mozambican health system

PURPOSE

Within an overarching evaluation framework, this study explored the experiences of course participants and administrators of an intercountry master's degree in nursing between South Africa and Mozambique. The lessons learnt were used to inform nursing and health policy for the Mozambican health system.

METHODS

Kirkpatrick's four levels of training evaluation and a results-oriented approach to capacity change were integrated to form a hybrid evaluation framework to capture information about course implementation and the context/environment within which it was delivered. The study used quantitative and qualitative methods including a self-administered survey of course participants, document review, in-depth, semi-structured interviews with course administrators and two focus group discussions with course participants.

FINDINGS

Participants enrolled in the course primarily to gain new knowledge and to improve health outcomes; course participants and administrators responded positively to the course design, course implementation and the quality of teaching. Knowledge and skills gained help to build graduates' confidence and boost their attitude towards nursing. Paradoxically, graduates felt powerless to transfer knowledge and effect change in practice.

CONCLUSION

This collaborative, capacity development project produced postgraduate nurses in two areas of specialization, namely, critical care and trauma nursing and maternal and neonatal health. While course participants gained significant benefits in new skills and knowledge and a higher degree qualification, the rewards available to them in the public health system remain unclear.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Lessons learnt may serve to influence policy decisions about the role of the Ministry of Health and other stakeholders in sustaining the output and quality of postgraduate nurses for the Mozambican health system. A strategic approach informed by multilevel policies at government, organizational and managerial levels should be adopted to systematically minimize and remove barriers to the transfer and utilization of knowledge and skills in the workplace.